Screening for depressive illness in adult populations

Depression is a major cause of disability worldwide. Screening in at-risk populations is important in identifying those at most need of treatment. Pengpid et al report on high rates of incident and persistent symptoms of depression identified in an epidemiological study in a Thai population and their association with physical comorbidities. However, there are limitations to screening, due to both resource implications and the risk of diagnostic overshadowing. Although screening is useful in providing an overview of the prevalence of depressive symptoms from an epidemiological perspective, there may be justified concerns in translating this approach to clinical settings. This is especially true where the resources to provide further comprehensive assessment and treatment may be inadequate. Clinically there is a need to consider a more complete approach to screening that utilises screening tools embedded in a wider diagnostic approach which allows the detection and management of other confounding conditions

A descriptive epidemiological study of mastitis in 12 Irish dairy herds

<p/> <p>Factors relating to the occurrence of mastitis were studied on 12 Irish dairy herds with histories of elevated somatic cell count (SCC) and/or increased incidence of clinical mastitis cases. Milk recording data were analysed, housing conditions and calving areas were examined; dry cow therapy, clinical mastitis records, milking technique and aspects of milking machine function were assessed.</p> <p>Herds with a ratio of less than 110 cubicles per 100 cows were more likely to experience environmental mastitis. Herds with inadequate calving facilities, where cows spent prolonged periods on straw bedding, were likely to acquire environmental mastitis. In the majority of the herds, the selection of dry cow therapy lacked adequate planning. The majority of farmers took no action to reduce pain experienced by cows suffering mastitis. Deficiencies in parlour hygiene were evident in all herds experiencing elevation in SCC.</p

Prevalence of pathogens causing subclinical mastitis in 15 dairy herds in the Republic of Ireland

<p/> <p>Milk samples from 285 cows in 15 dairy herds were collected for bacteriological analysis. Cows were selected on the basis of a somatic cell count (SCC) exceeding 200,000 cells per ml at the three most recent milk recordings prior to sampling. <it>Staphylococcus aureus </it>and <it>Streptococcus uberis </it>were the predominant isolates accounting for 21% (n = 61) and 19% (n = 53) of isolates, respectively. <it>Streptococcus uberis </it>was more frequently isolated from split-calving herds than from spring-calving herds and this difference was statistically significant (P < 0.005). Herds with suboptimal housing had a significantly greater prevalence of <it>S. uberis </it>than did herds where housing was adequate (P < 0.005). The isolation rates for <it>S. aureus </it>was significantly greater in herds where parlour hygiene was suboptimal (P < 0.05).</p

Promoting Healthy Behaviour Choices: Understanding Patient Challenges by Undertaking a Personal Behaviour Change Task

INTRODUCTION: Unhealthy behaviours such as poor diet, smoking and physical inactivity contribute significantly to chronic disease. Our first year medical school project aims to increase student awareness of: the importance of these behaviours and their systematic measurement; recommended behaviour targets in health professional guidelines; challenges in achieving patient behaviour change; and psychological theories which aid behaviour change. METHODS: Students are provided with evidence-based health behaviour guidelines for prevention of heart disease. Students select whichever behaviour they would personally like to achieve improvement in, systematically record behaviour for one week (baseline), and then try to implement (healthy) behaviour change for the next two weeks, using psychological theory as an aide. Students report their results and discuss outcomes reflecting on explanations for the success or otherwise of their behaviour attempts. A virtual learning environment (Moodle) ensures project engagement and completion during the relevant timeframes. RESULTS: This assignment has been successfully completed by students over previous academic years. The use of deadlines for uploading sections of coursework to Moodle (e.g. baseline data) has increased the quality and completeness of the projects. Students learn to use standard instruments such as the Fagerstrom Test for Nicotine Dependence and also learn recommended professional guidelines on diet and physical activity at an early point in a medical training. Also, self-reported health behaviours improved over the course of the assignment. CONCLUSIONS: This project allows students to test the difficulty of adhering to professional advice they themselves will give to future patients. The assignment combines knowledge (e.g. education on chronic conditions, on the role of behaviour change and on professional guidelines), skills (e.g. documenting behaviours, planning and implementing change) and attitudes (e.g. on understanding the difficulties encountered by individuals when making and sustaining recommended behaviour change). The novel use of a virtual learning environment ensures high participation

Electronic surveillance for healthcare-associated central line-associated bloodstream infections outside the intensive care unit

Background.Manual surveillance for central line-associated bloodstream infections (CLABSIs) by infection prevention practitioners is time-consuming and often limited to intensive care units (ICUs). An automated surveillance system using existing databases with patient-level variables and microbiology data was investigated.Methods.Patients with a positive blood culture in 4 non-ICU wards at Barnes-Jewish Hospital between July 1, 2005, and December 31, 2006, were evaluated. CLABSI determination for these patients was made via 2 sources; a manual chart review and an automated review from electronically available data. Agreement between these 2 sources was used to develop the best-fit electronic algorithm that used a set of rules to identify a CLABSI. Sensitivity, specificity, predictive values, and Pearson's correlation were calculated for the various rule sets, using manual chart review as the reference standard.Results.During the study period, 391 positive blood cultures from 331 patients were evaluated. Eighty-five (22%) of these were confirmed to be CLABSI by manual chart review. The best-fit model included presence of a catheter, blood culture positive for known pathogen or blood culture with a common skin contaminant confirmed by a second positive culture and the presence of fever, and no positive cultures with the same organism from another sterile site. The best-performing rule set had an overall sensitivity of 95.2%, specificity of 97.5%, positive predictive value of 90%, and negative predictive value of 99.2% compared with intensive manual surveillance.Conclusions.Although CLABSIs were slightly overpredicted by electronic surveillance compared with manual chart review, the method offers the possibility of performing acceptably good surveillance in areas where resources do not allow for traditional manual surveillance.</jats:sec